[Reactivation of Epstein-Barr virus is involved in the pathogenesis of lymphomatoid granulomatosis].

Recent studies point to a role of Epstein-Barr virus in the pathogenesis of lymphomatoid granulomatosis. Little is however known about the association of the pathogenesis of the disease with Epstein-Barr virus reactivation. A 46-year-old man presented with fever and general malaise. He had been admitted with fever of unknown origin 10 years previously. Chest radiographs and CT scans showed multiple nodular shadows in both lung fields. PET/CT showed strong accumulation in lung nodules, femoral muscle, lumbar subcutaneous nodule. He died of rapidly progressive neurological lesions. The definitive diagnosis of lymphomatoid granulomatosis was made from histological findings of the surgical biopsy specimen and at autopsy. Elevation of early antigen-IgG titer in serum was shown in this case. This result suggests that reactivation of Epstein-Barr virus is involved in the development of the disease.

[A case of mesalazine-induced pleuritis with hemophagocytic findings].

A 25-year-old woman who had been receiving mesalazine for 2 weeks for ulcerative colitis presented with a nonproductive cough, high fever, and exertional dyspnea. Her chest radiograph showed bilateral pleural effusion. At first, infectious pleuritis was suspected and antibiotics were administered, but the pleural effusion increased and high fever continued. Because clinical and radiographic abnormalities markedly improved with discontinuation of mesalazine and treatment with corticosteroid, mesalazine was thought to be the cause of pleural effusion in this case. This case was thought to be of interest when we consider the onset mechanism of pleurisy by mesalazine. Mesalazine-induced pleuritis must be considered in patients who develop unexplained respiratory symptoms while taking this agent.

[A case of gastric cancer initially presented by bilateral chylothorax].

The patient, a 66-year-old woman, visited our hospital with chief complaints of nocturnal coughing and dyspnea. Chest radiography revealed bilateral pleural effusion, and she was admitted to our hospital to undergo more thorough examination. The bilateral pleural effusion was identified as chyle. In cytodiagnosis, a number of poorly-differentiated adenocarcinoma cells in clumps were detected, and mucus was found in the cell bodies. The case was diagnosed as signet-ring cell carcinoma. Endoscopy of the upper digestive tract was performed for close examination of the primary lesion. As a result, a IIc lesion accompanied with concentrated folds and hypertrophy was found on the anterior wall of the body of the stomach. Biopsy of this site led to a diagnosis of signet-ring cell carcinoma, and these results were consistent with the cytodiagnostic findings of pleural effusion. Because gastric carcinoma associated with bilateral chylothorax is very rare in Japan, we report the results of our study with some discussions based on a review of the literature.

A patient with adult Still's disease with an increased Chlamydia pneumoniae antibody titer.

Adult Still's disease is an important differential diagnosis of pyretic disease and it does not necessarily appear to be a distinct disease entity. The etiology of adult Still's disease is not yet known. However, it has been considered that adult Still's disease may be triggered by certain infections, such as the Coxsackie, parvo B19, rubella, mumps, Epstein-Barr, and cytomegalo virus, as well as mycoplasma, toxoplasma, and so on. Recently, we experienced a patient with adult Still's disease with an increased Chlamydia pneumoniae antibody titer. The titer decreased slowly after the beginning of steroid therapy, associated with improvement of clinical symptoms. In this report we mention the relationship between the pathogenesis of adult Still's disease and a high titer of Chlamydia pneumoniae antibody.